1821150970 NPI number — FAMILY EYECARE CENTER

Table of content: (NPI 1821150970)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821150970 NPI number — FAMILY EYECARE CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY EYECARE CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821150970
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/26/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1500 HARRISON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELKINS
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26241-3327
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-636-9111
Provider Business Mailing Address Fax Number:
614-923-9575

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 HARRISON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELKINS
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26241-3327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-636-9111
Provider Business Practice Location Address Fax Number:
614-923-9575
Provider Enumeration Date:
12/15/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TINGLER
Authorized Official First Name:
CHRISTY
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
BILLING CLERK
Authorized Official Telephone Number:
304-636-9111

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  867-OD , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1821150970 . This is a "GROUP NPI" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 0149464000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3810006295 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0150280000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1992795835 . This is a "NPI CRAIG C. HYRE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 1447240205 . This is a "NPI EDWARD CLIFTON HYRE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".